Rural Health

Most rural Georgia residents in a new survey say they have experienced problems with the affordability of health insurance and the cost of health care.

When asked the biggest problem facing local health care, 68 percent named cost, with quality of care and access to care trailing far behind, according to the survey of 491 people. It was conducted by Opinion Savvy and commissioned by Healthcare Georgia Foundation.

The poll may be the first to focus entirely on rural health care issues in Georgia. It comes in the wake of four rural hospital closings in the state since the beginning of 2013.

Those hospitals closed due to financial problems, and the economic and medical effects of their loss have drawn the attention of Georgia’s political leadership.

Across America, rural residents generally lag far behind people in other areas when it comes to health and quality of medical care. full story

The state’s main health agency says it’s analyzing a new plan to cover more uninsured Georgians through a special Medicaid “waiver’’ program.

Clyde Reese

Gov. Nathan Deal “has asked us to work on it,’’ Clyde Reese, commissioner of the state Department of Community Health, said Thursday.

The plan for a Medicaid waiver was generated by Grady Health System as an alternative to Medicaid expansion under the Affordable Care Act, a step that has been firmly rejected by Deal and state legislative leaders.

The Grady plan focuses on using federal matching Medicaid dollars to help set up pilot sites that would give coverage to the uninsured, then manage their care and potentially improve their health.

Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial sites in the coverage plan, which has generated much interest and speculation within the state’s health care industry.

Meanwhile, a safety-net health system in Cleveland, Ohio, told GHN that a similar program there –- cited as a model for the Grady plan -– helped improve many patients’ health and was carried out at costs below budget estimates. full story

Grady Health System realized it couldn’t count on Medicaid expansion anytime soon, so it went looking for a different path.

Expansion, already implemented in a number of other states, would have extended coverage to hundreds of thousands of low-income Georgians – turning them into paying patients. By doing that, it would have helped Atlanta’s Grady Memorial and other hospitals offset deep federal cuts looming from the Affordable Care Act.

But Gov. Nathan Deal and the Republican-led Georgia General Assembly stood firmly opposed to expanding Medicaid because of the cost.

Grady Memorial Hospital

So Grady officials began to envision a smaller-scale insurance program that could avoid the political and financial pitfalls that accompany a Medicaid initiative.

What they and state officials are proposing is a plan where federal matching Medicaid dollars would be used to help set up pilot sites that would give coverage to the uninsured, then manage their care and potentially improve their health.

Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial players in the coverage plan. full story

A health care company CEO says he was “speechless and stunned” when the feds asked Georgia to return more than $100 million in payments made to his firm’s nursing homes.

Ronnie Rollins

Ronnie Rollins, CEO of Macon-based Community Health Services of Georgia, said in an interview Monday that company nursing homes had received the extra Medicaid funding in question for more than a decade without a problem. Then, this past December, a federal ruling declared the funding to be inappropriate.

A Dec. 8 letter and report from the federal Centers for Medicare and Medicaid Services said the “unallowable’’ payments to more than 30 nursing homes were made in fiscal years 2010 and 2011.

But CMS also asked Georgia to return any similarly inappropriate payments for more recent fiscal years as well, pushing the total sought, according to state officials, to an estimated $248 million.

Rollins said Monday that the extra funding under “upper payment limit’’ (UPL) regulations had been approved by state and federal agencies for his nursing homes since 2001.

Still, he said, he was not surprised at the overall federal intention to cut off these funds. full story

Dr. Roslyn Banks-Jackson worries about what will happen to many women of Emanuel County when the local hospital shuts its labor and delivery unit.

Dr. Roslyn Banks-Jackson

She’s the only ob/gyn currently practicing in the east-central Georgia county. And the practice, Emanuel OB/GYN Clinic, owned by the hospital, will soon be closing as well.

Many of her low-income patients have no transportation, and they either walk or have to get rides from friends or relatives to get to their appointments.

When the closures come, those of Banks-Jackson’s patients who do have cars will be driving 30 to 40 minutes to other counties to deliver their babies, said her office manager, Ashley Williamson. Some patients may wind up delivering in the local emergency room, Williamson added.

Emanuel Medical Center, citing high costs and low reimbursements, decided last month to close the hospital’s obstetrical program June 30.

The shuttering of the labor and delivery unit follows similar actions by other hospitals across the state. The obstetrical closures have hit especially hard in rural Georgia, where health care has been imperiled by doctor shortages and shaky hospital finances. full story